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Question:

From Michigan, USA:

My 7 year old son was diagnosed Type 1 at 22 months. He weighs about 48 pounds, and takes 2.5 to 3.5 units Regular (sliding scale) and 6 Lente in the A.M. and 2 or 2.5 Humalog and 5 Ultralente at dinner. We recently switched from Regular to Humalog at dinner because his early morning blood glucose levels were either very high or very low, depending on whether he had 4 or 4.5 units Ultralente, and the dinner Regular seemed to make him very sensitive to small changes in the Ultralente. Now his bedtime reading is usually great (140-180), but he is consistently very high all night into wake-up time. We have gradually increased the P.M. Ultralente from 4 to 5 units gradually to no avail. Should we keep increasing the dinner time Ultralente? We've considered switching from Ultralente at dinner to a bedtime Lente shot, but want to avoid the extra shot if possible. Our (excellent) diabetes team is similarly stumped. Any suggestions?

Answer:

A few suggestions to consider and discuss with your team:

  1. If 4.0 units of Ultralente in the evening is too little, and 4.5 units is too much, you could dilute the Ultralente so you could accurately give 4.25 units.

  2. Adding a small dose of Ultralente in the A.M. may carry over to the nighttime (you may have to decrease the A.M. Lente a little bit).

  3. Adding a small dose of Lente to the evening dose may help.

  4. Adding a small dose of Regular to the evening dose may help.

The more insulins you give during the day, the harder it is to figure out when they are working and which insulins overlap. By changing or adding only one insulin at a time (and avoiding or limiting sliding scales for a while), you will have a better chance of learning when each insulin is working. In young children, you have to be especially careful to avoid middle of the night lows when trying to lower the blood sugars at bedtime and before breakfast. It is important to test once or twice during the night when you are making changes to make sure your child's blood sugar is not dropping during sleep.

In my practice I often mix 3 or 4 insulins together to try and get smaller doses of insulin working at different times of the day and avoid a third shot. I mix combinations of Humalog, Regular, Lente, and Ultralente. Sometimes it works, sometimes it doesn't, but it's worth a try.

TGL

Original posting 4 Mar 1998
Posted to Insulin

  
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Last Updated: Tuesday April 06, 2010 15:08:56
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